Organization
UNIVERSITY OF ILLINOIS - CHICAGO
Active
Parent organization
UNIVERSITY OF ILLINOIS
Other names
College of Applied Health Sciences Faculty Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF ILLINOIS
Authorized official
DR. BO L. FERNHALL PHD (DIRECTOR)
(312) 413-1567
Entity
Organization
Contact information
Practice address
1640 W ROOSEVELT RD, ROOM 336 (MC 628), CHICAGO, IL 60608-1316
(312) 413-1567
(312) 413-1993
Mailing address
5254 SOLUTION CENTER, CHICAGO, IL 60677-0001
(312) 413-1567
(312) 413-1993
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
222Q00000X
Developmental Therapist
—
—
225100000X
Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
07/06/2006
Last updated
01/20/2022
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